CASS: There’s No Good Reason Not to Have a PAD Program

Ian Quinones was just 13 when he had his cardiac arrest, collapsing during a 2010 gym class at Rincon Middle School in Escondido, Calif. Fortunately those around him knew what to do: They called 9-1-1, started CPR, and ran for the school’s defibrillator. They used it on him. He survived.

It was the only AED in the school district.

With that anecdote, shared Wednesday at the Cardiac Arrest Survival Summit in Seattle, speaker Loralee Olejnik, MA, EMT-B, underscored the difference even a first small step can make in a public-access defibrillation program. Her session was aimed at those whose communities still don’t have PAD programs but also had plenty for those maintaining them.

The first objection typically raised to PAD proposals is cost. But there are multiple and creative ways to finance them, said Olejnik, who spent a decade with San Diego’s Project Heart Beat. Grants are a common method, but the idea also resonates well for fundraisers, bonds (both school and municipal), and charitable donations. Be creative: Partners like law enforcement may be able to subsume AED costs into their overall vehicle costs. Vendors may be willing to partner and offer deals.

Grants require certain elements, and hiring a professional grant-writer is an option, but if you’re willing to develop the skills in-house, their usefulness is ongoing. “Write one grant, and you’ve written them all,” Olejnik joked. Of course some specific requirements vary by grantor, but generally you’ll want to paint a compelling story, describing the need, your mission, anticipated impact, and other funding mechanisms to be used. Develop a stock pitch you can adapt.

Do thorough research for potential granting organizations—funds can come from sources you wouldn’t expect. Walmart, for instance, awards community grants, and Amtrak gives sponsorships and charitable contributions.

Before you start soliciting support, align a foundation of stakeholders. PAD programs should include a medical director and first responders, and adding elected officials to the team can be a great asset. Consider other healthcare figures, school and parent groups, and cardiac arrest survivors. Sports teams can be powerful allies; San Diego Project Heart Beat partners with baseball’s Padres each year for a mass CPR training before a home game. Such mass trainings help rally support. Approach it like a PR tour, Olejnik said.

Have an AED deployment plan that provides the most bang for supporting bucks. We know where people gather: schools, gyms, theaters, malls, etc. Don’t forget vehicles like buses and police cars that can expand an AED’s range. The emerging frontier here is residential placement: High-rises and planned communities with central locations like clubhouses can make AEDs available to large numbers of people at home. (Earlier in the day Singapore’s EMS medical director, Marcus Ong, MD, described his country’s efforts to get them into half of the ubiquitous high-rises that house 90% of Singaporeans.)

Of course know and understand all your state and local laws pertaining to AED placement and use. Liability fears are common, but per the CDC, all 50 states have some degree of Good Samaritan protection for lay AED scenarios. Develop SOPs for program operation and maintenance and consider adding PAD laws to municipal codes where applicable.

When evaluating specific AED models, weigh not only the deal a vendor can offer but the needs of your community. Perhaps your AEDs should be multilingual or compatible with local EMS equipment.

Remember to budget for maintenance—that’s an important piece often forgotten, Olejnik said. Once you’re up and running, program management should also entail regular collection of data and sharing it with hospitals. In San Diego someone was on call 24/7 to do that—when a public AED was used, they went immediately to retrieve the data and deliver it to the ED. That prevented more than one mistaken discharge when ED staff thought a resolved arrest was just a seizure. Leverage all available technology, such as alert apps, AED mapping, and cell phone video. 

Cardiac arrest is a major killer, and saves are great stories, so don’t be shy about promoting your program and celebrating successes with local media. Make a big deal of donations and hold trainings in unique environments. San Diego Project Heart Beat held one aboard the aircraft carrier U.S.S. Midway. And needless to say, ongoing measurement and quality assurance and improvement are vital. Knowing who’s using your AEDs and where can help prove value and identify remaining gaps.

Most of the objections to PAD programs, Olejnik concluded, are a function of ignorance and can be dispelled with education, so keep that priority in mind. The Quinones family would likely agree.

John Erich is the senior editor of EMS World.